3D Printed Simulator Could Help Surgeons Prepare for a Rare and Complex Pediatric Surgery

Premature infants can be afflicted with all sorts of life-threatening conditions; one of those is esophageal atresia, where the esophagus does not connect to the stomach. Instead, the upper esophagus abruptly ends, often as a small pouch. In other cases, the lower esophagus connects to the windpipe, creating even more complications. The latter condition is particularly dangerous and requires quick intervention if the baby is to survive. Thankfully, esophageal atresia is rare, but that rarity makes it difficult for surgeons to train in operating on the condition.

Training is essential, however, as the keyhole surgery is complex with no room for error.

“The stakes are extremely high,” said Dr. Jon Wells of Christchurch Hospital in New Zealand. “You have to get it right the first time.”

Dr. Wells’ colleague, Professor Spencer Beasley, is a pediatric surgeon at the hospital and is one of the foremost experts on esophageal atresia in the world.

Dr. Jon Wells, left, and Professor Spencer Beasley

“We normally do the surgery within a day or so of birth, which entails separating the lower section of oesophagus from the windpipe and connecting it to the upper section so the baby can swallow saliva and food,” he said. “Up until now, people have their first attempt at doing the surgery with actual patients.”

That’s scary for both surgeons and for the families of the babies being operated on. No matter how skilled a surgeon is, any first-time surgery is going to be difficult, especially a complex one like that required for esophageal atresia. The area being operated on is about the size of a matchbox, said Dr. Wells. In the past, surgeons would make large incisions to access the esophageal tubes, but in more recent years they have opted to take the keyhole approach to minimize pain and recovery time.

Any practice that surgeons got with the procedure tended to require animal tissue or even live animals.

A 3D printed model, however, presents none of those problems, and Beasley and Dr. Wells came up with the idea to 3D print a model of a baby’s ribcage, based on a CT scan of a real baby, so that surgeons could practice the surgery as much as they needed to before having to operate on an actual infant. They also developed a synthetic skin and a replica of an esophagus and windpipe with the most common form of esophageal atresia. It includes different layers of synthetic tissue that behave naturally and cause issues that a surgeon would encounter in a real operation.

The 3D printed ribcage is reusable, and the internal organs can be cheaply and easily replaced so that surgeons can practice the operation as many times as necessary.

“One of our aims is to make this model deliberately cheap so it can be used anywhere in the world,” said Beasley.

Dr. Wells recently took the simulator to an international conference on keyhole surgery on children. The experts at the conference said the simulator was realistic, but Dr. Wells and Beasley must still prove that it actually improves surgeons’ skills before it is ready for medical schools. They will continue to work on developing the 3D printed simulator, but it shows a lot of promise for surgeons to be more prepared when they undertake their first keyhole surgeries for esophageal atresia.

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